December 2011
What You Need to Know About Lower Respiratory Tract Infections and Nursing Homes
Infectious Disease; Pulmonology Medicine
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Pneumonia and other lower respiratory tract infections (LRTIs) are the second most common infections among nursing home residents and the leading cause of death from infections in the long-term care setting. The Pennsylvania Patient Safety Authority recently published data that shows LRTIs in Pennsylvania nursing homes increased by six percent and the number of influenza-like illnesses (ILIs) increased by 28 percent from the previous year. Nursing homes have received this information and know about strategies they can put into place to reduce the likelihood of a resident getting a LRTI. This information is useful for you, the consumer, to know as well so you can know more about LRTIs and ILIs and ask the right questions if you or someone you know is living in a long-term care facility. 

Residents Who Are More at Risk for LRTI and ILI 

Elderly long-term care facility residents are more likely to get a LRTI if they have certain conditions and other risk factors such as the following: difficulty swallowing (dysphagia), smoke, did not receive the flu or pneumonia vaccine, not able to walk, have feeding tubes, do not have their teeth cleaned regularly or properly, underlying disease, or have overall poor health. 

Why Proper Teeth Cleaning is Important and Lowers Risk for LRTI and ILI 

More than 20 percent of all cases of pneumonia could be avoided in the nursing home setting if residents’ teeth are properly cleaned and those residents with difficulty swallowing are identified as high risk for aspiration. Bacteria in dental plaque is believed to cause more residents to suffer from aspiration pneumonia. 

Aspiration pneumonia is inflammation of the lungs and airways to the lungs from breathing in foreign material (usually foods, liquids, vomit, bacteria in the mouth or fluids from the mouth).

Residents at high risk for lung infections associated with poor teeth cleaning habits are residents with natural teeth, swallowing disorders, those who are not able to clean their own teeth, those who have dry mouth and those residents who must use a ventilator and can’t swallow or cough to clear their throat. 

Dry mouth, or xerostomia,is a common side effect experienced by those who take multiple medications. This condition  increases the risk for gum disease because saliva contains cleaning components as well as minerals that can help rebuild tooth enamel after eating something acidic or with decay-causing bacteria. 

Why Residents with Difficulty Swallowing (Dysphagia) Must Be Closely Watched 

Residents with difficulty swallowing are seven times more at risk for aspiration pneumonia which, if acquired in a nursing home, has the highest mortality of any healthcare-acquired infection.

It is estimated that 30 percent of pneumonia in long-term settings is caused by aspiration.

Nursing homes can help prevent LRTIs and ILIs in residents with swallowing problems by completing a checklist that contains important information developed specifically for residents with difficulty swallowing. Items include a complete study of the resident’s past health history and eating habits. More strategies and details of the checklist can be found in the 2011 December Patient Safety Advisory article “Strategies to Improve Outcomes in Nursing Home Residents with Modifiable Risk Factors for Respiratory Tract Infections,” on the Authority’s website at www.patientsafetyauthority.org. 

Why Flu and Pneumonia Vaccines are Important in Reducing LRTI and ILI 
  • Studies of healthcare vaccination programs have found as high as 60 percent of flu virus infections in residents can be prevented when 100 percent of staff are vaccinated. 
In Pennsylvania 
  • In review of Pennsylvania data, nursing homes that have mandatory vaccination programs in place have about 20 percent lower LRTI/ILI infection rates compared to nursing homes without mandatory staff vaccinations. 
  • The Authority, from this data set, estimates that almost 2000 more respiratory tract infections could have been prevented among all Pennsylvania nursing homes if they had a mandatory vaccination program in place.
Points to Remember for an Effective Plan to Reduce LRTIs and ILIs in a Nursing Home 
  1. An effective teeth cleaning program includes education and assessment, handling resistance to care, giving tooth brushing options, and managing dry mouth. 
  2. Swallowing difficulty (dysphagia) and aspiration risk factors can be lessened with a structured history and physical assessment or study, a personal care plan, use of medical testing to learn more about the resident’s condition, use of drugs that specifically help residents with swallowing problems, use of swallowing therapy, consideration of feeding tubes as an alternative and stimulate  hormones that affect swallowing by brushing the resident’s teeth and gums regularly. 
  3. The vaccination of healthcare workers can reduce the number of flu cases by 60 percent in nursing homes if all staff are vaccinated. 

For more information on how lower respiratory tract infections can be reduced in a nursing home, go to the December 2011 Patient Safety Advisory article, Strategies to Improve Outcomes in Nursing Home Residents with Modifiable Risk Factors for Respiratory Tract Infections,” at www.patientsafetyauthority.org. 

©2018 Pennsylvania Patient Safety Authority